Prehepatic jaundice is characterized by a sharp increase in the level of bilirubin in the blood, followed by yellowing of the skin, mucous membranes and eyeballs. The disease is provoked by a malfunction of the erythrocyte system, in which the breakdown of erythrocytes is observed, which leads to an increase in bilirubin.
The liver does not have time to process and remove the liver pigment, which first penetrates the bile ducts and intestines and then circulates further through the body. The disease often develops against the background of infectious, autoimmune diseases, poisoning and may have a genetic factor.
Feature of the disease
Often, yellowish skin tone is caused by problems with the biliary tract and liver, when these organs cannot bind the released bilirubin and remove it from the body naturally. However, it also happens that these organs function quite normally, but bilirubin still accumulates in large quantities.
A similar condition is possible with suprahepatic jaundice. This pathology is characterizedexcessive destruction of blood cells, when red blood cells break down, and hemoglobin is converted to bilirubin, which does not have time to be processed and penetrates back into the blood. The pathogenesis of suprahepatic jaundice can be associated with malaria, lobar pneumonia, and other diseases that provoke increased breakdown of red blood cells.
The skin becomes lemon yellow, the patients are very pale, but there is no itching characteristic of other forms of jaundice. Blood tests do not show elevated levels of bilirubin. Among the symptoms of suprahepatic jaundice, swelling of the spleen should be distinguished, which can be detected by palpation, but the liver remains of normal size. The disease can be congenital or acquired.
Congenital suprahepatic jaundice is a disease characterized by problems with red blood cells, when a significant amount of red blood cells are destroyed, and new cells are not formed enough. Normally, erythrocytes live for about 4 months, and with the course of such a disease - a maximum of 3 weeks. In this case, the destruction of red blood cells in the liver, blood vessels, bone marrow, spleen.
In acquired suprahepatic jaundice, red blood cells are destroyed in the spleen. In children, such a violation is mainly due to adaptation to a new unusual environment. In adults, the disease occurs when blood diseases or other he alth problems.
Illness in infants
Suprahepatic and subhepatic jaundice of newborns are divided into physiologicaland pathological. The physiological form of the disease resolves on its own in 1-1.5 weeks. However, if during this time the symptoms of the disease do not go away or other signs join, then this may indicate the course of the pathology. In this case, you need to urgently consult a doctor. The first symptoms of jaundice appear in a child on the second day after birth.
Physiological jaundice is not dangerous, as it occurs as a reaction of the body to a sharp breakdown of hemoglobin during defective liver function, which cannot cope with its main task. The pathogenesis of suprahepatic jaundice in children is the same as in adults. The pathological form of the disease can be provoked by factors such as:
- thyroid problems;
- congenital pathologies;
- immature liver cells;
- Rhesus conflict between mother and child;
- infectious liver diseases;
- complication of diabetes during pregnancy.
Often the main cause of suprahepatic jaundice is the Rh conflict, as the cells of the mother's body throughout pregnancy attack the cells of the fetus, recognizing them as pathological. Basically, the first signs of the disease appear even in the maternity hospital, which increases the chances of a positive outcome and helps prevent the development of complications.
Suprahepatic jaundice is characterized by symptoms such as:
- jaundice of the sclera of the eyes and skin;
- pallor;
- sluggishness.
There are several different shapeshemolytic jaundice in a newborn baby, such as:
- anemic;
- edematous;
- icteric.
The anemic form of the disease is quite easily tolerated by the child, since it is only a short period of aggressive exposure of the mother's antibodies to the fetus. At the same time, such signs as pale skin, anemia, an increase in the size of the spleen and liver are noted.
Basically, the development of suprahepatic jaundice is a consequence of prolonged exposure of maternal antibodies to the child. The edematous form is considered very dangerous and can lead to the death of the baby. At the same time, there are such symptoms of suprahepatic jaundice as:
- severe anemia;
- enlarged liver, spleen, heart;
- deterioration of liver function;
- heart problems;
- puffiness;
- accumulation of fluid in the pleura and abdomen.
Due to edema, the weight of a newborn baby exceeds the norm by 2 times. In addition, the occurrence of ascites, significant bruising is characteristic. Often there is pericarditis and pleurisy, which also occurs due to severe swelling.
The icteric form of the disease occurs when antibodies begin to attack the cells of an already formed organism. At the same time, the newborn baby is completely he althy. Symptoms increase gradually, and the manifestation of the disease reaches its peak approximately 4 days after the birth of the child. It is worth noting that the earlier signs of jaundice begin to appear, the more difficult the clinic. After a while the babythe skin begins to turn yellow, and the spleen, liver and lymph nodes increase.
Signs of jaundice and bilirubin increase so that after a while the skin becomes dark yellow, almost brown or with a slight greenish tint, and the bilirubin levels in the blood are growing rapidly. Basically, the disease lasts about a month.
With suprahepatic jaundice, bilirubin accumulates in the body and negatively affects the functioning of the heart, liver and nervous system. The child is very lethargic and refuses food. Occasional seizures and breathing problems may occur.
With the development of the nuclear form of jaundice, the child's he alth begins to deteriorate very sharply. In case of severe intoxication and the lack of proper and timely treatment, convulsions become more frequent, trembling occurs in the limbs. Also among the signs should be noted tension and stiffness of the muscles of the neck. The child becomes almost immobile, he has no facial expressions, his eyes roll down, and he only squeaks as a reaction to external stimuli.
Treatment of newborns should be immediate. The basis of therapy is the normalization of the spleen and liver in the process of binding and neutralizing bilirubin. To improve the well-being of the child requires the use of complex treatment. During therapy, medications and physiotherapy techniques are used. You may also need a blood transfusion.
It is strictly forbidden to self-medicate a small child. When the first signs appearsuprahepatic jaundice in infants, you need to contact a pediatric neonatologist. Improvement occurs almost immediately after the start of therapy.
One of the methods of therapy in infants is fluorescent lighting with a special lamp. It helps to convert bilirubin into a safe substance that is excreted from the body through physiological bowel movements. Treatment is carried out exclusively in a hospital. In this case, it is necessary to ensure all conditions for the safety of the procedure. The essence of the technique is that the child is placed in a special box or simply under a lamp. During treatment, frequent breastfeeding of the baby is required, since excess bilirubin is excreted with food debris.
If the level of bilirubin significantly exceeds the norm, it becomes very dangerous for the he alth and life of the child. In this case, he is shown a blood transfusion. To do this, donor blood is injected through the umbilical vein, which helps to cleanse the body of a dangerous substance. This is the most extreme measure, as it is accompanied by various adverse effects, so this procedure is performed in cases where other methods of therapy do not bring the desired result.
Causes of occurrence
Any kind of jaundice is not an independent disease, but only signals the presence of certain changes or disorders in the functioning of internal organs. Therefore, yellowing of the eyes and skin is characteristic not only for hepatitis, but also for many other diseases. The main cause of suprahepatic jaundice is a sharp jump in the levelbilirubin to the maximum value. This condition provokes a large breakdown of red blood cells.
The etiology and pathogenesis of suprahepatic jaundice in adults are associated with:
- infectious causes;
- immune disorders;
- toxic effects;
- heredity.
In hereditary anemia, an anomaly in the structure of red blood cells is observed against the background of the occurrence of abnormal lipids and proteins. They visually change, and also have low resistance to changes in temperature and pressure.
The etiology of suprahepatic jaundice can be very different, but often the process is due to biochemical processes. Therefore, the detection of overt jaundice is not difficult. It is much more difficult to determine the causes of jaundice, as they are observed in many non-communicable and infectious diseases. The development of suprahepatic jaundice is a consequence of:
- gallstone disease;
- impaired bile outflow;
- blockage of liver ducts;
- cholecystitis and other diseases of the gallbladder;
- pancreatitis and destruction of the pancreas.
This form of the disease is associated with hemolysis and accumulation in the blood of the unbound fraction of the bile pigment - bilirubin. It is very important to recognize the course of the disease in a timely manner and treat it.
Main symptoms
Regardless of the etiology of suprahepatic jaundice, the manifestation of the disease is practically the same. Among the main signs, it is necessary to highlight the staining of the mucous membranes and skin in yellow. Maina symptom is a change in biochemical parameters in suprahepatic jaundice, namely, an increase in the level of bile pigment (bilirubin) in the blood serum, which leads to icteric staining of tissues.
It is worth considering that the yellowness of the skin may be due to other reasons. This may be due to the deposition of certain substances in the tissues, in particular when working in hazardous industries or taking quinacrine.
Suprahepatic jaundice is characterized by the presence of symptoms such as:
- enlargement of the liver, which can be detected by palpation and ultrasound;
- coloring the whites of the eyes and skin in a yellow tint;
- dilation of the veins of the esophagus;
- sharp pain in the right side under the ribs;
- the appearance of a venous network on the skin of the abdomen;
- change in the composition and color of feces and urine.
In addition, there is an increase in the spleen, severe pallor, increased production of red blood cells in the bone marrow. Among the characteristic manifestations of suprahepatic jaundice, it is necessary to highlight the intense color of feces. The liver cannot properly cope with the large amount of bilirubin formed during the active breakdown of red blood cells. In this case, the main symptoms are accompanied by a pulling pain in the spleen area, chills, a sharp decrease in hemoglobin.
Development mechanism
The mechanism of suprahepatic jaundice may be due to increased breakdown of red blood cells, bile stasis, liver damage, or a combination of all of these factors. When conducting a diagnosis, it is necessary to take into account the peculiarity of the violation of pigment metabolism. This form of the diseaseis due to the fact that in a he althy person about 1% of red blood cells decay daily. With the breakdown of hemoglobin in the blood, bilirubin is formed in the cells, which does not dissolve in water and is not excreted with urine. However, at the same time, it dissolves well in fats, therefore it accumulates in the subcutaneous fatty tissue. Over time, bilirubin, moving through the intestines and accumulating in the large intestine, turns into a pigment that stains the feces brown. This can be determined during the survey.
When the liver function is impaired, the level of bilirubin in the blood increases. The mechanism of development of suprahepatic jaundice is triggered if the pigment does not enter the bile capillaries, but back into the space inside the liver, and then into the blood. However, another variation is also possible. In addition, chronic disease is also possible.
Jaundice can occur as a result of obstruction of the bile ducts, such as blockage by a stone. At the same time, a bile pigment, bilirubin, accumulates in the blood. Thus, according to the mechanism of development, suprahepatic, subhepatic and hepatic jaundices are distinguished. Its type is determined in differential diagnosis.
Pathophysiology
Severe damage to hepatocytes is characteristic of suprahepatic jaundice. This type of disease can also occur in hepatitis of various etiologies, cirrhosis of the liver, as well as other diseases that occur with necrosis of the cells of this organ. At the same time, there are quite characteristic signs of the development and course of the disease. In the event of a pronouncedsymptoms need a comprehensive diagnosis.
Diagnosis
Primary diagnosis of suprahepatic jaundice, namely a visual examination is carried out to determine the presence of yellowness of the skin and sclera of the eyes. Then, to confirm the diagnosis, methods such as:
- urine and blood test;
- antiglobulin test;
- bone marrow puncture;
- ultrasound diagnosis of the liver and biliary tract.
With suprahepatic jaundice, blood biochemistry is prescribed first of all, since this analysis allows you to determine the level of bilirubin. A biochemical blood test is carried out by taking blood from a vein in the morning strictly on an empty stomach. If the blood formula is changed, then the patient is additionally prescribed liver tests, which will show dangerous deviations in the functioning of the liver. An antiglobulin test allows you to determine the presence of antibodies to red blood cells. If there is a suspicion of an infectious lesion of the liver, then a laboratory blood test for hepatitis is prescribed.
It is worth noting that it is the suprahepatic form of jaundice that is most easily diagnosed. This is explained by the fact that the symptoms of the disease are quite pronounced. The skin is lemon-colored with a strong pallor, and there is no itchy skin that is characteristic of other types of jaundice.
In blood tests, an increased content of indirect bilirubin is noted, while direct bilirubin remains normal. Cholesterol levels and liver tests also remain within normal limits. Only complexdiagnostics allows you to determine the peculiarity of the course of the disease, as well as prescribe a comprehensive treatment.
Providing treatment
Therapy is carried out in a complex and can be conservative or operational. When choosing a technique and prescribing drugs, bilirubin indicators and the severity of the pathology are taken into account.
Treatment of suprahepatic (hemolytic) jaundice is based on the elimination of the causes that provoked this disease. Conservative therapy means:
- use of antibacterial drugs;
- glucocorticoids;
- carrying out phototherapy.
In order to reduce signs of intoxication, glucose or saline is infused. If the disease was provoked by various autoimmune processes, then the introduction of glucocorticosteroids, in particular such as Dexamentasone or Prednisolone, is indicated. In addition, immunosuppressants are prescribed.
In some cases, individual blood components may be transfused. This procedure is resorted to very rarely, when the level of bilirubin is very high. Direct transfusion is practically not used. Simultaneously with blood transfusion, phototherapy is prescribed, which helps to convert indirect bilirubin into non-toxic. Irradiation is carried out using white or blue fluorescent lamps. In severe forms of the disease due to biochemical defects in red blood cells, the removal of the spleen is required.
Since an increase in bilirubin in the blood can be triggeredseveral different causes, the treatment is carried out by several specialists at once. Hemolytic forms of the disease are mainly related to blood diseases, so a consultation with a hematologist is required. An examination by a toxicologist is also required, since jaundice can be triggered by poisoning with hepatotropic toxins. In any case, the subhepatic form of the disease requires the consultation of a surgeon or an oncologist.
Etiotropic therapy is also obligatory, aimed at eliminating the main cause that provoked the pathology. If the outflow of bile is obstructed by a gallstone, then treatment involves an operation during which a foreign body is removed. However, it is worth remembering that etiotropic treatment is not always possible. Although the cause of hereditary subhepatic jaundice is always known, there are no treatments that can correct existing defects in the genes that lead to premature destruction of red blood cells.
Pathogenetic therapy is aimed at individual links of the mechanism that lead to the onset of a disease or deterioration in the patient's well-being. In particular, infusion therapy may be carried out, in which intravenous infusions of saline or other detoxification agents are used to help eliminate excess bilirubin by the kidneys.
It is also recommended to use diuretics, saline solutions, colloids. These drugs help cleanse the blood. To restore the liver, hepatoprotectors are required, which are used as part of complex therapy. by the mostcommon means are essential phospholipids, which contribute to the restoration of the functioning of this organ. Bile is diluted with choleretic drugs, and vitamins are introduced to strengthen the walls of blood vessels.
Treatment of the suprahepatic form at the initial stage is necessarily carried out in a hospital. It is important to be constantly under the supervision of a doctor so that pathological changes in the level of bilirubin, as well as the functionality of the liver, can be detected in a timely manner.
Surgical intervention is prescribed very rarely when there is a high degree of tissue damage. For treatment, alternative methods can also be used, which are auxiliary and are used together with traditional medicine. The most popular are recipes based on kelp, burdock, sorrel, milk thistle and other herbs from which decoctions are prepared. As a choleretic agent, dandelion roots and flowers, freshly squeezed vegetable juices are used. The use of alternative methods of therapy must be agreed with the attending physician.
Dieting
A patient with jaundice must strictly adhere to the doctor's recommendations regarding nutrition, which will help unload the liver. Animals and refractory fats are the most difficult to digest. It is strictly forbidden to consume spicy, fried, s alty, fatty, smoked foods. All types of alcoholic beverages are strictly prohibited.
It is best if the basis of the diet is oatmeal orbuckwheat, low-fat varieties of fish or meat, thermally processed vegetables, crackers. It is also possible that durum wheat pasta, as well as low-fat dairy products, are present in the diet. Food should contain many vitamins and minerals. Additionally, if necessary, the doctor may prescribe vitamin complexes.
It is necessary to normalize the diet. It is recommended to eat 5-6 times a day in small portions. Food must be chewed thoroughly. Diet therapy occupies a very important place in the treatment of diseases of the liver and biliary tract. The main purpose of the diet is to reduce the load on the liver. It is recommended to increase fluid intake if there are no contraindications.
Prognosis after treatment
Prognosis after treatment of adult patients is quite good. If the disease was provoked by intoxication of the body, then after a complete purification of the blood, all existing signs disappear almost immediately. With autoimmune causes of subhepatic jaundice, treatment with glucocorticosteroids gives a very good effect.
The most favorable prognosis will be if treatment was started at the initial stages of the course of the disease. The recurrence of jaundice is possible with the development of cholelithiasis, so one of the important areas of therapy will be the normalization of metabolism. It is very important to follow a dietary diet and all doctor's prescriptions.
After eliminating the main cause of the disease and correcting nutrition, the process of producing and removing bilirubin from the body is completely restored. With the right andcomplex treatment stops the breakdown of red blood cells and an increase in the level of bilirubin in the blood. If jaundice was provoked by Gilbert's syndrome, then no special treatment is required, since it does not pose a danger to human he alth.
Possible Complications
If jaundice occurs after the 29th week of pregnancy, there is a high risk of miscarriage or fetal death. With untimely help, the child dies. If you start treatment on time and do not deviate from the recommendations of the doctor, then, most likely, the disease will be completely overcome and will not leave behind any additional ailments and complications. If the baby suffered bilirubin encephalopathy, and he was not provided with medical assistance, then the consequences may be partial or complete hearing loss, developmental delays, paralysis.
In adults, a complication of jaundice can trigger the development of many different diseases, in particular such as:
- pancreatitis;
- sepsis;
- cholangitis;
- cirrhosis of the liver;
- kidney failure.
In addition, complications may be associated with diseases that provoked the development of jaundice. Cholangitis, especially the purulent type of the disease, is usually triggered by gallstone disease.
Prophylaxis
To reduce the risk of jaundice, preventive measures must be taken. As a preventive measure, you should take only those medicines that have been prescribed by your doctor. It is necessary to undergo a diagnosis if a blood transfusion was performedand after that, yellowing of the skin appeared.
During pregnancy, you must strictly follow all the doctor's prescriptions, eat well and eliminate bad habits. If, when registering, a woman has a negative Rh factor in her blood, then she should be immediately included in the risk group. In this case, computer diagnostics and monitoring of the level of antibodies in the blood are carried out.
The main diagnostic method is ultrasound, since with the help of such a technique it is possible to determine the thickness of the placenta, the degree of its growth, the condition of the spleen and liver. Determination of possible fetal hypoxia is also required. Every trimester, a pregnant woman should be tested for antibodies. In this case, there is every chance to give birth to a he althy child with well-developed organs. The baby's body easily copes with the increase in bilirubin, and the signs of jaundice are mild or completely absent.
In the first week after the birth of a child, it is recommended to arrange sunbathing for him. On the second day, you need to put the baby in a sunny place for 10 minutes and carry out a similar procedure 1-2 times a day. However, you need to do everything very carefully, protecting your eyes from bright sunlight, and your skin from burns.
